For the past several decades a rather depressing health statistic has remained essentially the same, namely, that four out of every five Americans experience lower back pain and associated effects.  While we are not aware of the corresponding ratio for upper back pain, it is undoubtedly too high and certainly, based on our observations, a prominent physical problem that is becoming increasingly more common in adults of all ages.

Of course, there are many probable causes for discomfort in the lower back, upper back and neck areas, and it is unlikely that any simple or single solution will successfully remediate or prevent all such problems.  Nevertheless, two factors are typically identified as major contributors to reduced integrity of the spinal column which can clearly lead to pain and related physical problems.  These increasingly common factors, both associated with sedentary lifestyles, are muscle weakness and poor posture.  Unfortunately, each of these problems adversely affects the other, as muscle weakness can result from poor posture and poor posture can result from muscle weakness.

Fifteen years of research from the University of Florida Medical School has demonstrated that regular strength exercise for the lumbar spine muscles can significantly reduce or eliminate low back pain in a large percentage of patients.  It is therefore logical to assume that strengthening the muscles of the upper back and neck may likewise benefit people who suffer discomfort in these areas of the body.  While there is less research quantifying the relationship between posture and pain, it is most likely that better posture will produce a corresponding reduction in spine-related discomfort. 

My colleague, Scott Worobey MSPT, has a research interest in the forward head-rounded shoulder posture that has become a common problem often observed in physical therapy evaluations.  According to clinicians, this faulty posture frequently leads to neck, shoulder and back discomfort.  For example, rounded shoulders may cause mechanical malfunction of the shoulder joint resulting in tendon impingement, bursitis, and rotator cuff injury.  It is also possible that this posture causes increased feelings of fatigue due to the greater muscle tension and activation necessary for support purposes.  Rounded shoulders may result in a kyphotic posture which puts additional pressure on the thoracic spine, resulting in reduced bone density, micro-factures and loss of height.  Add to these concerns the problems associated with forward head posture.  The forward head position causes the weight of the head (approximately 15-pounds) to pull at the cervical spine, which may lead to muscle tightness, spasm and chronic tension headaches. 

Research Study

We designed a study to determine whether a fitness program including aerobic activity, strength training, stretching exercise and postural awareness would improve forward head-rounded shoulder posture and increase standing height.

Thirty-four men and women (average age 45 years) completed the 10-week posture intervention program, which was conducted twice a week in six-person exercise classes with two instructors per class.  Each class was one-hour in length and included about 20 minutes of aerobic activity (stationary cycling and treadmill walking), 20 minutes of strength training (10 Nautilus machines), and 10 stretching exercises.  The participants performed one set of 8 to 12 repetitions of the following resistance machine exercises for the major muscle groups.  Each strength exercise was followed by a 20-second static stretch for the muscle group just worked.  For example, the leg extension exercise was followed by a 20-second quadriceps stretch and the leg curl exercise was followed by a 20-second hamstrings stretch.

In addition to the basic program of endurance, strength and flexibility exercise, all of the program participants received relevant information, verbal cues and positive reinforcement on proper posture.  Two specific stretches for the chest and shoulder muscles were presented by the lead class instructor who holds a masters degree in physical therapy.

Assessment Procedures

All of the study subjects were assessed before and after the 10-week training period for changes in body composition (lean weight and fat weight), as well as for forward head position and standing height.  The participants experienced a 1.5-percent improvement in body composition, resulting from a 2 1/2-pound gain in lean (muscle) weight and a 3-pound loss of fat weight.  Their forward head position improved by almost 1/2 inch, and their standing height increased by almost 1/4 inch. 

Practical Application

Based on these findings, the 10-week program of basic endurance, strength and flexibility exercise is effective for replacing muscle and reducing fat.  When combined with postural awareness training and two specific stretches for the chest and shoulder muscles, the basic exercise program is also beneficial for improving functional posture, decreasing forward head distance and increasing standing height.  Written questionnaire surveys completed by the participants prior to the final assessment revealed an overwhelmingly positive response to the training program.  Their comments included noticeable improvements in personal posture, reduced neck and shoulder area discomfort, and less low back pain.  Essentially all of the respondents committed to continued postural awareness and a regular exercise regimen, therefore indicating that they perceived the program components to be both physically important and personally beneficial.  Although the long-term outcomes of the posture intervention program are not known, the short-term effects are clearly encouraging. 

Back to Articles